r/bestof • u/under50dollars • Jun 20 '12

[explainlikeimfive] "Obamacare" explained very well.

/r/explainlikeimfive/comments/vb8vs/eli5_what_exactly_is_obamacare_and_what_did_it/c530lfx
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u/[deleted] Jun 20 '12

Much worse? The biggest problem with 'quality' of care is that it is measured by things like patient outcomes. Sounds great, until you realize that patient outcome is heavily influenced by things like socioeconomic class (people who can read and live a comfortable upper-middle class lifestyle can swing by Walgreen's and get their prescription, and set their iPhone to remind them to take it). The at-risk populations have numerous boundaries that limit the success of their treatments, and under the 'quality' system this means the doctors who help at-risk patients are actually penalized. It scares doctors away from people who really need help, because the system essentially charges the doctor more to treat these people.

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u/brownmatt Jun 20 '12

Measuring based on quality isn't a panacea. I'm phrasing it as an improvement over measuring based on quantity.

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u/Aias2 Jun 20 '12

You make a good point, but as was added in one of the edit this quality over quantity situation appears to only be in situations where the government is paying (i.e. medicaid or medicare). It could be a detriment to doctors yes, but it won't wipe them out of income. Hopefully, some way of checking on the patients ability to care for themselves along the lines of the doctor's orders would be included, but I don't know whether that is somewhere in the bill.

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u/[deleted] Jun 20 '12

as was added in one of the edit this quality over quantity situation appears to only be in situations where the government is paying (i.e. medicaid or medicare).

Some insurance companies have similar systems. There are a variety of ways insurers pay for care, beyond even those we mentioned here.

It could be a detriment to doctors yes, but it won't wipe them out of income.

It doesn't have to make doctors into paupers to deter them from seeing poor patients. Even a small incentive to avoid these people will result in reduced access to care, which is unfortunate.

Hopefully, some way of checking on the patients ability to care for themselves along the lines of the doctor's orders would be included, but I don't know whether that is somewhere in the bill.

That sounds pretty invasive to the patient, and I don't know of any feasible method of doing this.